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Autonomy residents safety

Brandon M Wojcik, Zhi Ven Fong, Madhukar S Patel, David C Chang, Emil Petrusa, John T Mullen, Roy Phitayakorn
OBJECTIVE: General surgery training has evolved to align with changes in work hour restrictions, supervision regulations, and reimbursement practices. This has culminated in a lack of operative autonomy, leaving residents feeling inadequately prepared to perform surgery independently when beginning fellowship or practice. A resident-run minor surgery clinic increases junior resident autonomy, but its effects on patient outcomes have not been formally established. This pilot study evaluated the safety of implementing a resident-run minor surgery clinic within a university-based general surgery training program...
November 2016: Journal of Surgical Education
Carla Ferreira do Nascimento, Yeda Aparecida Oliveira Duarte, Maria Lúcia Lebrão, Alexandre Dias Porto Chiavegatto Filho
PURPOSE OF THE STUDY: To analyze a representative sample of older individuals of São Paulo, Brazil, according to outdoor fallers, indoor fallers and non-fallers, and to identify biological and socioeconomic (individual and contextual) factors associated with the occurrence and place of falls. MATERIALS AND METHODS: A cross-sectional study was conducted using data (n = 1345) from the 2010 wave of the Health, Wellbeing and Aging (SABE) Study, a representative sample of older residents (60 years and older) of São Paulo, Brazil...
January 2017: Archives of Gerontology and Geriatrics
Elizabeth A Evans, Elizabeth Perkins, Pam Clarke, Alina Haines, Ashley Baldwin, Richard Whittington
OBJECTIVE: To determine how care home managers negotiate the conflict between maintaining a safe environment while enabling the autonomy of residents with dementia. This is important because there is limited research with care home managers; yet, they are key agents in the implementation of national policies. METHOD: Semi-structured interviews were conducted with 18 managers from care homes offering dementia care in the Northwest of England. Data were analysed using a thematic analysis approach...
October 21, 2016: Aging & Mental Health
Daniel A Hashimoto, William E Bynum, Keith D Lillemoe, Ajit K Sachdeva
The graduate medical education system is tasked with training competent and autonomous health care providers while also improving patient safety, delivering more efficient care, and cutting costs. Concerns about resident autonomy and preparation for independent and safe practice appear to be growing, and the field of surgery faces unique challenges in preparing graduates for independent practice. Multiple factors are contributing to an erosion of resident autonomy and decreased operative experience, including differing views of autonomy, financial forces, duty hours regulations, and diverse community health care needs...
June 2016: Academic Medicine: Journal of the Association of American Medical Colleges
Jeanne M Franzone, Benjamin C Kennedy, HelenMari Merritt, Jessica T Casey, Melissa C Austin, Timothy J Daskivich
BACKGROUND: Progressive independence in patient care activities is imperative for residents' readiness for practice and patient safety of those cared for by graduates of residency programs. However, establishing a standardized system of progressive independence is an ongoing challenge in graduate medical education. OBJECTIVE: We aggregated trainees' perspectives on progressive independence, developed a model of the ideal state, and suggested actionable improvements...
December 2015: Journal of Graduate Medical Education
Malini D Sur, Nancy Schindler, Puneet Singh, Peter Angelos, Alexander Langerman
BACKGROUND: Poor communication is a known contributor to disasters in aviation and medicine. Crew members are trained to raise concerns about superiors' plans, yet literature exploring surgical trainees' responses to analogous concerns is sparse. METHODS: Surgical residents were interviewed about approaches to concerns about supervisors' clinical decisions using a semistructured guide. Emerging themes were developed using the constant comparative method. RESULTS: Eighteen residents participated...
February 2016: American Journal of Surgery
Thomas H Cogbill, Stephen B Shapiro
Surgical training graduates require a period of adjustment as they transform from trainees to experienced surgeons. Making a smooth transition is important for patient safety and new surgeon success. A subset of current graduates does not feel confident to enter directly into practice. Residency design with curriculum refocus, credentialing to encourage graded responsibility, and increased operative exposure is necessary. Onboarding programs should include formal mentoring, career counseling, proctoring by senior surgeons, and objective review of outcomes...
February 2016: Surgical Clinics of North America
Dominique Piquette, Carol-Anne Moulton, Vicki R LeBlanc
RATIONALE: Progressive trainee autonomy is considered essential for clinical learning, but potentially harmful for patients. How clinical supervisors and medical trainees establish progressive levels of autonomy in acute care environments without compromising patient safety is largely unknown. OBJECTIVES: To explore how bedside interactions among supervisors and trainees relate to trainee involvement in patient care and to clinical oversight. METHODS: We conducted a qualitative study based on constructivist grounded theory methodology...
April 2015: Annals of the American Thoracic Society
Jennifer Stevens, Anna Johansson, Inga Lennes, Douglas Hsu, Anjala Tess, Michael Howell
OBJECTIVES: Increasing attention to patient safety in training hospitals may come at the expense of trainee autonomy and professional growth. This study sought to examine changes in medical trainees' self-reported behaviour after the institution-wide implementation of a rapid response system. METHODS: We conducted a two-point cross-sectional survey of medical trainees in 2006, during the implementation of a rapid response system, and in 2010, in a single academic medical centre...
December 2014: Medical Education
Sébastien Lachance, Jean-François Latulippe, Luc Valiquette, Gaétan Langlois, Yvan Douville, Gerald M Fried, Carole Richard
OBJECTIVE: Quebec was the first Canadian province to implement a 16-hour workday restriction. Our aim was to assess and compare Quebec's surgical residents' and professors' perception regarding the effects on the educational environment, quality of care, and quality of life. DESIGN: The Surgical Theater Educational Environment Measure, the Postgraduate Hospital Educational Environment Measure, quality of the medical act, and quality-of-life questionnaires were administered 6 months after the work-hour restrictions...
September 2014: Journal of Surgical Education
Joshua T Hanson, Read G Pierce, Gurpreet Dhaliwal
Regulations that restrict resident work hours and call for increased resident supervision have increased attending physician presence in the hospital during the nighttime. The resulting increased interactions between attendings and trainees provide an important opportunity and obligation to enhance the quality of learning that takes place in the hospital between 6 PM and 8 AM. Nighttime education should be transformed in a way that maintains clinical productivity for both attending and resident physicians, integrates high-quality teaching and curricula, and achieves a balance between patient safety and resident autonomy...
February 2014: Academic Medicine: Journal of the Association of American Medical Colleges
Kyle J Rehder, Ira M Cheifetz, Douglas F Willson, David A Turner
BACKGROUND: In recent years, the focus on patient safety and housestaff supervision has led to a steady increase in institutions providing 24/7 in-hospital (also known as in-house, henceforth referred to as IH) coverage by pediatric intensivists. Effects of this increased attending physician presence on education of pediatric housestaff have not been studied. We hypothesized that IH coverage would decrease perceived autonomy of housestaff and negatively affect their preparedness to be independent attending physicians on completion of training...
January 2014: Pediatrics
Merja Sallinen, Outi Hentonen, Anne Kärki
PURPOSE: The purpose of the study was to explore whether or not the assistive and safety technology that is currently used in service house environment supports the active agency of the elderly residents. METHOD: Twelve purposively chosen elderly residents were interviewed. The data were analyzed by theory-driven content analysis using the modalities of the agency-model as a theoretical frame. RESULTS: The technological devices and systems partially support the active agency of the residents...
January 2015: Disability and Rehabilitation. Assistive Technology
Elizabeth A Di Napoli, Gloria Lauren Breland, Rebecca S Allen
OBJECTIVES: Adults hold negative attitudes toward sexual expression in late life. We investigated knowledge and attitudes about older adult sexuality and dementia among staff in nursing homes (NHs). METHOD: We acquired staff demographics, knowledge of dementia and sexuality, and attitudes of sexuality. Staff participated in focus groups and received continuing education credit. RESULTS: The three NHs had an average census of 178 beds. Participants' (N=100) mean age was 38...
October 2013: Journal of Aging and Health
Lisa M Quintiliani, Hillary L Bishop, Mary L Greaney, Jessica A Whiteley
Nontraditional college students (older, part-time, and/or working) have less healthful nutrition and physical activity behaviors compared to traditional students, yet few health promotion efforts focus on nontraditional students. The purpose of this study was to use qualitative methods to explore factors affecting nutrition and physical activity behaviors of nontraditional students. Fourteen semi-structured individual interviews were conducted with nontraditional undergraduate students attending a large university...
October 2012: Nutrition Research
Adam A Rosenberg, Carol Kamin, Anita Duhl Glicken, M Douglas Jones
BACKGROUND: Resident training in pediatrics currently entails similar training for all residents in a fragmented curriculum with relatively little attention to the career plans of individual residents. OBJECTIVES: To explore strengths and gaps in training for residents planning a career in primary care pediatrics and to present strategies for addressing the gaps. METHODS: Surveys were sent to all graduates of the University of Colorado Denver Pediatric Residency Program (2003-2006) 3 years after completion of training...
September 2011: Journal of Graduate Medical Education
Carol Harvey, Eoin Killackey, Aaron Groves, Helen Herrman
OBJECTIVE: Access to adequate housing consistent with personal preferences and needs is a human right and supports recovery from psychosis. This study aimed to: (1) describe people with psychosis living in different housing types, and their preferences and needs; (2) explore selected demographic and social inclusion correlates in relation to housing; and (3) compare two subgroups - participants living in supported group accommodation and supported housing - on key demographic, functional, clinical and social inclusion variables...
September 2012: Australian and New Zealand Journal of Psychiatry
Meeta Prasad Kerlin, Scott D Halpern
There is an inherent tension between the training needs of inexperienced clinicians and the safety of the patients for whom they are responsible. Our society has accepted this tension as a necessary trade-off to maintain a competent workforce of physicians year after year. However, recent trends in medical education have diminished resident autonomy in favor of the safety of current patients. One dramatic example is the rapid increase in the number of academic ICUs that provide coverage by attending physicians at all hours...
May 2012: Chest
Jeanne M Farnan, Lindsey A Petty, Emily Georgitis, Shannon Martin, Emily Chiu, Meryl Prochaska, Vineet M Arora
PURPOSE: To summarize the literature regarding the effect of clinical supervision on patient and educational outcomes, especially in light of the recent (2010) Accreditation Council for Graduate Medical Education report that recommends augmented supervision to improve resident education and patient safety. METHOD: The authors searched the English-language literature from 1966 to 2010 using electronic databases and a hand search. They included studies that described a controlled design, and they have relayed the effects of supervision on patient- and education-related outcomes...
April 2012: Academic Medicine: Journal of the Association of American Medical Colleges
Maria Manuel Sá, Rui Azevedo, Maria Cristina Martins, Osvaldo Machado, João Tavares
This study aims to create awareness, both within the scientific community and among providers of sports facilities, for individuals with impaired or reduced mobility, promoting the development of technical solutions that allow greater autonomy and social integration of people with disabilities. The purpose of this work is, on the one hand, to evaluate the accessibility of sports facilities for people with reduced mobility and, on the other hand, to investigate why this user group has such low rates of participation in sporting activities...
2012: Work: a Journal of Prevention, Assessment, and Rehabilitation
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